Committee leader wants more oversight of Mission Hospital

Friday

Mar 23, 2012 at 11:12 PM

The co-chair of a House select committee is proposing stricter oversight of Mission Hospital under its Certificate of Public Advantage, and one aspect of his proposals could affect the Mission Pardee Health Campus in Fletcher.

By Mark SchulmanTimes-News Staff Writer

The co-chair of a House select committee is proposing stricter oversight of Mission Hospital under its Certificate of Public Advantage, and one aspect of his proposals could affect the Mission Pardee Health Campus in Fletcher.Rep. Fred Steen said he released the recommendations at a committee meeting in Raleigh last week to initiate discussions before an April meeting on Mission's practices.The proposals could be the foundation of possible future legislation in the House.The COPA is an agreement Mission entered into in 1995 when the Asheville-based hospital merged with St. Joseph's. Because Mission is the only hospital system in Buncombe County and the largest in Western North Carolina, the agreement requires the state to monitor and regulate the hospital system.Steen, co-chair of The N.C. House of Representatives Select Committee on Certificate of Need and Related Hospital Issues, recommended:-- Establishment of a 10-mile buffer zone between other hospitals and health care services operated by Mission.-- The state could only eliminate the COPA if there is evidence of true competition with Mission.u Certificates of Need under the COPA must prove the health care service is necessary through a third-party study.-- The COPA employment cap would be extended to Mission's true service area.-- Mission would be subject to more frequent financial and operational audits.Mission officials said jobs would be eliminated if Steen's recommendations are put into legislation and access to health care would be reduced, particularly in rural areas."The recommendations would greatly impact Mission Health's ability to provide quality health care throughout Western North Carolina by restricting Mission's ability to recruit and retain qualified physicians," Ron Paulus, president and CEO of Mission Health, said in a prepared statement.Paulus pointed out that Mission is the state's most highly regulated health system.Officials at Park Ridge Health in Fletcher have said Mission's expansion into Henderson County is predatory, and they think implementation of Steen's recommendations would be a move in the right direction."This is really a positive step and will preserve patient access and choice," said Graham Fields with Park Ridge and the WNC Community Healthcare Initiative. "This will also be helpful to hospitals and physicians in the region."Buffer zoneIf the state imposed a 10-mile buffer zone between Mission and other health services, such as Park Ridge, the Mission Pardee Health Campus on the Henderson and Buncombe county line would violate the new rule because it would be 4 miles from Park Ridge."Every other health system in the country would be able to expand throughout Western North Carolina without this restriction," Paulus said. "There is no precedent for such a ‘buffer zone,' which is antithetical to free markets and patient choice."The buffer zone would take away 6,000 square miles of the hospital's future growth, Paulus added.Steen said the county-line project could lead to physician job loss in the area."I personally think this should be heard again by all sides to see if this should or should not be allowed," he said. "But I don't know if the committee will go with (the recommendation)."Officials from Park Ridge have repeatedly said that the Mission-Pardee joint venture would bring an unnecessary duplication of services to the community.Removal of the COPAMission officials said the hospital system has outgrown COPA restrictions because competition has entered the health care market, but Steen said he would like more documentation on the matter.Per his recommendations, the state would only be able to eliminate the COPA if there is evidence of true competition with Mission."Since a COPA is a substitute for competition, only competition can replace a COPA," Steen's recommendation states.The request to remove the COPA should require a public filing, hearings, opportunity for public review and comment, the proposal says. The N.C. Department of Health and Human Services and the Attorney General's office would then provide a written decision.This process would be more transparent to the public and "is more in tune on how monopolies are handled in general," Steen said.Park Ridge officials said Steen's recommendations address their contention that the state has not regulated the COPA."Mission's reaction to the recommendations seems to be a distraction from the more important issue of exploring the true merits of these recommendations and the potential benefits to the people of Western North Carolina," Fields said. "It's really not about Mission, Park Ridge or any other health care provider; it's about the state's failure to monitor the COPA and the mess that has been left in its wake."Employment capUnder Steen's plan, the COPA employment cap, which states that Mission may employ no more than 30 percent of the physicians in Buncombe and Haywood counties, would be extended to Mission's true service area.Steen said the definition of employment would be expanded to include professional service agreements and exclusive contracts. Each county would be a unique market when determining physician employment, according to Steen's recommendations.AuditAnother of Steen's recommendations calls for Mission to have more frequent financial and operational audits. He would like the state to conduct a more comprehensive audit to determine how the COPA affects pricing of health services in Mission's service area.The committee will discuss Steen's recommendations at its April 19 meeting, but the group is not expected to take a vote because of the complexity of the issues."We are not trying to hurry," Steen said. "I just want these things on the table."If the committee does eventually vote to forward some or all of the recommendations to the House, they could be the basis for future legislation."We want to do no harm," Steen said. "We need to have all sides on common ground to move forward."Rep. Chuck McGrady, R-Henderson, who is not affiliated with the committee, said it is unlikely the proposals would be heard by the full House anytime soon."Any legislation that is complicated and contentious would not come in the short session," McGrady said of this year's session, which begins in May and ends in July. "We could take it up next year."And if the House does pass legislation stemming from Steen's proposals, state Sen. Tom Apodaca said the Senate would not entertain the COPA discussion, and any changes would not become law.Reach Schulman at 828-694-7890 or mark.schulman@blueridgenow.com.